What is the prognosis of primary hyperaldosteronism?

Updated: Sep 08, 2020
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Primary hyperaldosteronism can result in substantial morbidity and mortality as a result of hypertensive vascular complications (hypertrophy followed by sclerosis of intimal smooth muscle), renal complications (sclerosis), and cardiac complications (hypertrophy followed by dilatation). Through early recognition and treatment of hypertension, these complications can be avoided in children.

A study by Lai et al indicated that patients with autosomal dominant polycystic kidney disease (ADPKD) have a high prevalence of PA and that ADPKD patients with PA have an increased overall risk of cardiovascular disease. Surrogate markers showed a greater indication of atherosclerosis in these patients than in ADPKD patients with normal plasma aldosterone levels. The study included 27 hypertensive ADPKD patients, nine of whom (33%) had PA. [28]

Appropriate medical or surgical intervention in PA results in long-term reduction in blood pressure and left ventricle (LV) mass via LV inward remodeling (eg, through a reduction in LV diameters and volume). [29] Moreover, a significant decrease in urinary albumin excretion at 6 months after treatment has been reported in patients with PA and associated microalbuminuria. Both adrenalectomy and mineralocorticoid receptor antagonists can reverse the intrarenal hemodynamic pattern that leads to the decline in glomerular filtration rate and increased proteinuria. [13, 30] Furthermore, surgical or medical management of PA results in improvement in the metabolic complications of PA, such as plasma glucose control, and quality of life as well.

A study by Rossi et al found that patients with primary aldosteronism (PA) caused by an aldosterone-producing adenoma had, following adrenalectomy, a long-term atrial fibrillation–free survival rate comparable to that of optimally treated primary hypertension patients. However, medically treated patients with idiopathic hyperaldosteronism (IHA) had a lower long-term rate. The study’s median follow-up period was 11.8 years. The report’s results, according to the investigators, demonstrate the importance that early identification of PA patients requiring adrenalectomy has in the prevention of incident atrial fibrillation. [31]

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